1. The article begins dramatically: “The opioid epidemic is devastating America.” What evidence does the author provide to support this statement? Do you believe this claim is justified?

2. According to the author, why do people start using opioids? What are endorphins? What is their role in addiction? Explain the statement: “A drug like heroin creates a tidal wave in the reward circuits of the brain.”

3. How do opioids rewire the circuits of the brain? How do they cause pleasure and reward cycles to flip?

4. The article says, “You may not even realize you are physically dependent until you experience withdrawal for the first time.” What is withdrawal? What are its common effects? How do withdrawal and fear of withdrawal make opioid addiction so powerful?

5. Why do some treatment centers promote abstinence, while others provide medication? What are the advantages and disadvantages of either approach?

6. How long does treatment typically require? Why is recovery so difficult? According to the article, why is relapse so common?

7. The article says of the addiction phase: “It makes no sense, but this compulsion takes over all logic, judgment and self-interest. You may do things you never thought you could. Sell your body. Abandon your child. Steal from your mother. You might lose your job. Lose your home. Lose your loved ones.” Explain in your own words why opioids have the power to make a user lose all judgment. Do you think addiction absolves users of responsibility for their actions?

Finally, tell us more about what you think:

— What information from the article, if any, surprises you? Why? Has your perspective on opioid use and addiction changed?

— Return to the illustrations depicting stages of opioid use. How did your understanding of the illustrations change by reading the article? Select one and explain how it illustrates a specific stage of opioid use.

— Does the article change your understanding and feelings toward opioid users? If yes, how so? Choose one quotation from an opioid user in the article that made an impression on you. Explain why.

— Dr. Pedro Mateu-Gelabert, one of the nation’s top opioid researchers, says this work brings “an emotional understanding” to the epidemic “without glamorizing or oversimplifying.” Why is an emotional understanding of opioid use important? Do you think the New York Times article succeeds in accomplishing Dr. Mateu-Gelabert’s goal? Why or why not?